Massachusetts Water Resources Authority

MASSACHUSETTS WATER RESOURCES AUTHORITY

LANDFILL DISCHARGE PERMIT APPLICATION

INSTRUCTION SHEET

Landfills discharging landfill leachate, directly or indirectly to Massachusetts Water Resources Authority’s (MWRA’s) Sewerage System must have a Landfill Discharge Permit issued by the MWRA. Attached is a Landfill Discharge Permit Application. Instructions for completing and filing the Application are given below.

1. Answer all questions as thoroughly as possible.

2. The Application must be signed and dated by an Authorized Representative of the landfill to be valid.

For the questions that do not apply, please write “N/A” or “not applicable” in the space provided. Please do not leave the question blank because we may assume you missed the question and send the Application back to you.

If more space is needed, please attach additional pages.

If you have previously submitted information required by this Application and that information is unchanged, you must resubmit the information. If there are only minor changes, you may resubmit the information, and on a separate sheet indicate the changes that have occurred, with page references for each change

6. Attach a copy of evidence of the property title (for example, a deed of land ownership) for the sanitary landfill.

If you operate a leachate pretreatment system and you have not already done so, submit to the Massachusetts Department of Environmental Protection (MADEP) a request for classification of your pretreatment system by completing the attached pretreatment facility grading report form. Include a process flow diagram of the pretreatment system and send to:

Massachusetts Department of Environmental Protection

Board of Certification

DEP Training Center

Route 20

Millbury, MA 01527

Keep a copy of this completed Application for your records.

You must submit a completed Application to the MWRA no later than 60 days before your current permit expires in order for your current permit to remain in effect pending a decision on your Application.

MWRA Address: Municipality Addresses:

Massachusetts Water Resources Authority See Attached Municipal List

Toxic Reduction and Control

Chelsea Facility

Two Griffin Way

Chelsea, MA 02150-3334

If the landfill is owned and operated by an entity other than the municipality in which it is located, a copy of the completed Application must also be sent to the municipality. A list of municipal addresses is attached.

11. If you have any questions, please contact the MWRA Industrial Coordinator for the municipality in which you are operating. A list of MWRA Industrial Coordinators is attached.

MASSACHUSETTS WATER RESOURCES AUTHORITY

LANDFILL DISCHARGE PERMIT APPLICATION

TOXIC REDUCTION AND CONTROL

CHELSEA FACILITY

TWO GRIFFIN WAY

CHELSEA, MASSACHUSETTS 02150-3334

CONTENTS

SECTION A

GENERAL INFORMATION

SECTION B

/ LANDFILL USE AND DESIGN INFORMATION
SECTION C / LANDFILL OPERATIONAL INFORMATION
SECTION D / LANDFILL LEACHATE INFORMATION
SECTION E / ANALYTICAL RESULTS
SECTION F / SANITARY SEWER AND STORM SEWER CONNECTION INFORMATION
SECTION G / VEHICLE MAINTENANCE
SECTION H / REQUIRED DOCUMENTS SUBMISSIONS
SECTION I / OTHER FILINGS
Permit Number______/ Landfill Name______
Landfill Address______
______

MASSACHUSETTS WATER RESOURCES AUTHORITY

LANDFILL DISCHARGE PERMIT APPLICATION

SECTION A - GENERAL INFORMATION

Facility location (where your landfill is located and a contact person on the premises):

MUNICIPALITY or BUSINESS NAME:

CORPORATE NAME (if different):

ADDRESS:

CITY/TOWN:

STATE AND ZIP CODE:

CONTACT NAME:

CONTACT TITLE:

PHONE (INCLUDE AREA CODE):

FAX:

E-MAIL:

Permit address (where and to whom your permit and correspondence should be sent):

MUNICIPALITY or BUSINESS NAME:

CORPORATE NAME (if different):

ADDRESS:

CITY/TOWN:

STATE AND ZIP CODE:

CONTACT NAME:

CONTACT TITLE:

PHONE (INCLUDE AREA CODE):

FAX:

*E-MAIL:

*E-mail Address - required if you want the MWRA to send you e-mail when it receives analytical data from your laboratory via the e-SMART program.

Billing address (where and to whom bills and invoices should be sent):

BUSINESS NAME:

CORPORATE NAME (if different):

ADDRESS:

CITY/TOWN:

STATE AND ZIP CODE:

CONTACT NAME:

CONTACT TITLE:

PHONE (INCLUDE AREA CODE):

FAX:

E-MAIL:

Monitoring location (where your landfill leachate can be sampled):

MUNICIPALITY or BUSINESS NAME:

CORPORATE NAME (if different):

ADDRESS:

CITY/TOWN:

STATE:

CONTACT NAME:

CONTACT TITLE:

PHONE (INCLUDE AREA CODE):

FAX:

E-MAIL:

Check One: r Existing Discharge Date discharge began:______

r Proposed Discharge Anticipated date of initial discharge:

SECTION A - GENERAL INFORMATION

2. Name and Title of Authorized Representative (see next page for definition):

Note to Authorized Representative: In accordance with 40 CFR 403.14 and 360 CMR 10.011, information that identifies the nature and frequency of discharge shall be available to the public without restriction. Requests for confidential treatment of other information shall be governed by procedures specified in 360 C.M.R.§ 10.011. Should a discharge permit be required for your facility, the information in this questionnaire will be used to issue the permit.

I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

______

Signature of Authorized Representative Print the name of Authorized Representative

______

Title Date

SECTION A - GENERAL INFORMATION

Definition of Authorized Representative

For municipally owned landfills, an authorized representative is:

a) The principal executive officer, ranking elected official, or other duly authorized employee if such employee is responsible for the overall operation of the landfill.

b) the duly authorized representative of the individual designated in (a) of this section if:

i) the authorization is made in writing by the individual described in (a);

ii) the authorization specifies either an individual or a position having responsibility for the overall operation of the facility from which the discharge originates, such as the position of operator of the landfill, or a position of equivalent responsibility, or having overall responsibility for environmental matters for the municipality; and

iii) the written authorization is submitted to the MWRA.

For privately owned landfills, an authorized representative is:

(a) for a corporation, its (i) president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy-or decision-making functions for the corporation, or (ii) the manager of one or more manufacturing, production, or operation facilities employing more than 250 persons or having gross annual sales or expenditures exceeding $25 million (in second-quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.

(b) for a partnership or sole proprietorship, a general partner or proprietor.

i) the authorization is made in writing by the individual described in paragraph (a) or (b)

ii) the authorization specifies either an individual or a position having responsibility for the overall operation of the facility from which the Industrial Discharge originates, such as the position of plant manager or a position of equivalent responsibility, or having overall responsibility for environmental matters for the company; and

(iii) the written authorization is submitted with this form.

SECTION B – LANDFILL USE AND DESIGN INFORMATION

What is the current operating status of the landfill?

□Active Provide commencement date:

□Inactive Provide commencement and closure dates:

Provide a brief history of the landfill’s ownership and uses. (Attach a separate sheet if necessary.)

Indicate the predominant types of wastes deposited in the landfill as defined in DEP’s Solid Waste Management Regulations at 310 CMR 19.006.

□ Commercial Solid Waste / □ Special Waste
□ Construction and Demolition Waste / □ Sludge
□ Hazardous Waste / □ Wood Waste
□ Household Hazardous Waste / □ Agricultural Waste
□ Municipal Solid Waste / □ Source, special nuclear by-product material as defined by the Atomic Energy Act 1954, as amended
□ Septage and sewage as defined as 360 CMR 10.004
□ Other (describe):

4. What is the total area of the landfill? ______Acres

SECTION C – LANDFILL OPERATIONAL INFORMATION

Shift schedule:

First shift start______stop______# of employees ______

Second shift start______stop______# of employees ______

Third shift start______stop______# of employees ______

SECTION C – LANDFILL OPERATIONAL INFORMATION (continued)

Identify any security features utilized:

□Perimeter fence and locked gates Shift(s) or hours of operation: ______

□Security guard on duty Shift(s) or hours of operation: ______
□Surveillance by local police Shift(s) or hours of operation: ______

□Other (describe): ______Shift(s) or hours of operation: ______

Are any waste liquids or sludge removed from the facility site? □Yes □No

If yes, they may be best quantified as:

Waste Type Estimated

(Use the applicable units Gallons/Year, Cubic Feet/Year, or Cubic Yard/Year)

Waste Solvent ______

Oil (petroleum - based) ______

Grease (animal/vegetable-based) ______

Pretreatment Sludge ______

Inks/Dyes ______

Thinner ______

Paints ______

Acids and Alkalis ______

Pesticides ______

Other______

Attach a copy of the most recent Hazardous Waste Manifest for each applicable waste listed above. In place of Manifests, Large Quantity Hazardous Waste Generators may submit a copy of Part III, the Waste Summary, from their DEP Annual Waste Report.

State the name and address of any waste hauler(s) you have under contract to remove waste from the facility.

______

SECTION D – LANDFILL LEACHATE INFORMATION

What is the average leachate generation rate under dry and wet weather conditions?

______Gallons/Day (dry weather) ______Gallons/Day (wet weather)

Is the leachate treated prior to disposal? □Yes □No

If yes, provide a thorough description of the pretreatment system, indicate its location, and provide a process flow diagram of the pretreatment system. If more space is needed attach additional pages.

______

If yes, what is the pretreated leachate flow rate in Gallons/Day (GPD)? (Indicate measured or estimated)

For dry weather:

Average: ______GPD □ Measured □ Estimated

Maximum: ______GPD □ Measured □ Estimated

Minimum: ______GPD □ Measured □ Estimated

For wet weather:

Average: ______GPD □ Measured □ Estimated

Maximum: ______GPD □ Measured □ Estimated

Minimum: ______GPD □ Measured □ Estimated

Are flow records kept? □Yes □No

Do you have a flow-measuring device? □Yes □No

If yes, provide a description: ______

Provide the Massachusetts Department of Environmental Protection (DEP) classification for your pretreatment system. Pretreatment system class______

List the name(s) and DEP operator grade(s) for certified pretreatment system operators working at your facility.

Operator Name______Grade______

What is your method of disposal for sludge resulting from the pretreatment of leachate?

□Return it to the landfill

□Other (describe) ______

SECTION E – ANALYTICAL RESULTS

Please attach the analytical results for the past 12 month period of monitoring required by 310 CMR 19.132, including results from surface water, ground water leachate, secondary leachate collection, and leak detection systems.

SECTION F – SANITARY SEWER AND STORM SEWER CONNECTION INFORMATION

Please list the landfill sanitary sewer connections (assign a sequential connection number to each sewer connection). If there are more than 3 connections, attach additional connection information on a separate sheet of paper.

Connection Sewer Size Descriptive Location of Sewer Pre- Avg. Measured (M)

Number (GPD) (Inches) Connection or Discharge Point Treatment? Flow Rate Estimated (E)

(yes or no)

#1 ______

______

#2 ______

______

#3______

______

2. Provide a description of the storm water drainage system as required by 310 CMR 19.130(19) and the following connection information. Provide the slope and/or design flow for drains.

Connection Drain Size Descriptive Location of Storm Maximum Flow Measured (M)

Number (Inches) Connection or Discharge Point Rate (gpd) Estimated (E)

#1 ______

______

#2 ______

______

#3______

______

SECTION G – VEHICLE MAINTENANCE AND STORAGE

Is there a garage located on the site? □Yes □No

If yes, please indicate the approximate number of vehicles stored: ______

Are there floor drains located in the garage? □Yes □No

Are vehicles or other equipment washed on site? □Yes □No

If yes, please describe the types of vehicles and equipment washed:

Identify any other on-site maintenance performed on vehicles or equipment:

Attach copies of Material Safety Data Sheets (MSDS) for all detergents and chemicals used in the garage.

SECTION H – REQUIRED DOCUMENTS SUBMISSIONS

With this application, the applicant must submit the following documents that are applicable to the landfill. For each document that you do not submit, indicate below the reason why you have not submitted the document. If a document is inapplicable to the landfill, explain why. (For example, if you have not included a variance request because the landfill has not requested a variance, so indicate.):

a) Site assignment made pursuant to MGL c. 111 §§ 150 A and 150A1/2.